Adult CCRN?
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I'm an adult ICU nurse but my goal is to get a job in a PICU. We found out tonight that the hospital is offering a CCRN review course coming up and if you pass CCRN they'll reimburse you the cost of... Read More

Cushing's Triad is a VERY late sign of increased ICP in infants and children. I would hope that someone would have picked up on the problem long before that stage and done something... ventricular needle aspiration perhaps.

I was going to add to SarahBeth's; vomitting and lethargy. Do you get pupillary changes in infants?

When my son was about a year old, he hit his head pretty hard. Later that night he started projectile vomitting and acting really agitated. Turned out to be a stomach bug coincidentally, but I was scared for a while that he had a head injury. That's what you get when you combine a new dad with an ICU/former ER nurse! :-)

Both are also correct. And yes, you do indeed get pupillary changes in infants. They may also have temperature instability, apnea, seizure or perhaps sunset eyes. If you've never seen that before, let me tell you that it's one of the most freakish things I've ever seen. I was doing my senior practicum in nursing school my first time, carrying a baby with congenital CMV-related increase ICP. He squirmed, I looked down at him and nearly dropped him on his tight little head.

I'm enjoying the quizzes! I'm starting to study for the NICU CCRN, and obviously there is a lot of overlap in the PICU/NICU knowledge. (Although lots of differences too!)

Keep up the questions!

There definitely is a lot of overlap. NICUs typically only admit neonates while PICUs admit anybody from birth to 17 or older. Because our unit is primarily a cardiac surgical unit, we have many neonates; they usually go to NICU until their surgery then come to us post-op, but that isn't always the case. We've had at least one sectioned in OR#1 and carried across to OR#2 for immediate surgery (heart transplant) and then come directly to us.

New question:
What is considered to be adequate urine output for a four-year-old?

Feb 26, '10

Hmmm... Well, in babies we are hoping for at least 2 ml/kg/hour. I think it still goes by weight for bigger kids, but that's getting out of my territory. I'm going to guess 1-2 ml/kg/hour. I like this because some of your questions will relate to neonates and that's fun, but some will help me see the differences with big kids!

Feb 26, '10

1-2ml/kg/hour

Feb 26, '10

I guess I have to get up earlier in the afternoon to fool you. The answer would have been different if I'd asked about a four-year-old re-op Fontan patient. For them we're happy with 0.5-1 mL/hr in the first 24 hours.

I think in the interest of keeping this thread on-topic, I should start a new thread so dad2one (Bryan) can get more replies that pertain to his original post, and so that other interested parties can join in the fun. Off I go to do that.

Feb 27, '10

Hi Bryan
I am also an adult ICU nurse who got the opportunity to cross train this winter to the PICU to help out with the higher census during the winter months and totally I LOVE it!!! I took and passed he CCRN ( adult ) and now am thinking about taking the peds version. I am pretty sure you need to have a certain amount of time in the specialty area before you are allowed to take the exam unless it is different from the adult CCRN. I find Peds to be a whole different world from Adults !!! Even after 20 years as a nurse I am amazed how much I need to learn if I intend to switch over and work with this population.
Christine

Hi Bryan
I am also an adult ICU nurse who got the opportunity to cross train this winter to the PICU to help out with the higher census during the winter months and totally I LOVE it!!! I took and passed he CCRN ( adult ) and now am thinking about taking the peds version. I am pretty sure you need to have a certain amount of time in the specialty area before you are allowed to take the exam unless it is different from the adult CCRN. I find Peds to be a whole different world from Adults !!! Even after 20 years as a nurse I am amazed how much I need to learn if I intend to switch over and work with this population.
Christine

Yeah, you need to have 1750 hours in the specialty you're testing for (adult, PICU, NICU). So, I'd be taking the adult version, primarily to enhance my resume, but also I think just going through this review course the hospital is putting on would be a great learning experience. I've never had a critical care course where we just sit down and go over all this sort of thing before. It'd be nice to have it all at once to go over and cement everything in my mind. The person that teaches it is a CNS in critical care.

The diferences between adults and peds is primarily what draws me to the PICU. I particularly like the lack of lifestyle-related illness. That wears on me in the adult world.
Bryan

Feb 27, '10

I love the variety of ages and diverse treatments in the PICU. In my hospital your doing MCC -SCC-CV-Neuro-Trauma CC all on the one unit and it is not sectioned off into separate units like in the adult world and the kids are way cuter :-). I will probably make the change once I come back from a couple of years traveling ( doing adult CC while traveling). Good Luck. Christine

Feb 27, '10

Those are the main attractions that PICU has for me. The lack of lifestyle-related comorbidities and the variety... in my last four shifts I've looked after an school-aged kid post-VSD closure and tricuspid valve repair, done a 6 hour shift as an ECMO/CRRT specialist, cared for a neonate old post-Norwood on ECMO and cared for an infant with necrotizing pneumonia also on ECMO. On Monday it may be a post-op liver transplant or a croup. It's always different and it's always challenging.

Bryan, did you see the new thread I started?

Feb 28, '10

The variety is the other thing that really interests me.

Jan, yes I saw it. Our Internet at home is down so I'm having to use my iPhone. You think it's a pain typing a lot on a real keyboard? :-). It'll hopefully be back up tomorrow so I'll be participating again then. Phew, my thumbs are worn out from that!!!